<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">


    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Recharge_money')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-recharge_money" data-rule="required" class="form-control form-control" step="0.01" name="row[recharge_money]" type="number" value="0.00">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">汇款姓名:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-shop_name" data-rule="required" class="form-control form-control" name="row[shop_name]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">转入账户:</label>
        <div class="col-xs-12 col-sm-8">
            <table class="table table-bordered">
                <tr>
                    <th>账户名</th>
                    <th>银行名称</th>
                    <th>账户</th>
                </tr>
                <tr>
                    <td><input type="text" name="account" ></td>
                    <td><input type="text" name="bank_name" ></td>
                    <td><input type="text" name="account_no"  ></td>
                </tr>
            </table>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Recharge_image')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="input-group">
                <input id="c-recharge_image" data-rule="required" class="form-control form-control" size="50" name="row[recharge_image]" type="text" value="0">
                <div class="input-group-addon no-border no-padding">
                    <span><button type="button" id="plupload-recharge_image" class="btn btn-danger plupload" data-input-id="c-recharge_image" data-mimetype="image/gif,image/jpeg,image/png,image/jpg,image/bmp" data-multiple="false" data-preview-id="p-recharge_image"><i class="fa fa-upload"></i> {:__('Upload')}</button></span>
                    <span><button type="button" id="fachoose-recharge_image" class="btn btn-primary fachoose" data-input-id="c-recharge_image" data-mimetype="image/*" data-multiple="false"><i class="fa fa-list"></i> {:__('Choose')}</button></span>
                </div>
                <span class="msg-box n-right" for="c-recharge_image"></span>
            </div>
            <ul class="row list-inline plupload-preview" id="p-recharge_image"></ul>
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
